Flashcards in Diabetes Mellitus Deck (43):
What is Type 1 Diabetes?
An autoimune destruction of pancreatic beta cells resulting in a lack of insulin production
What is Type 2 Diabetes
Insulin resistance due to insulin signaling defect
What percent of women develop gestational diabetes?
4% or about 135,000 cases/yr
About how many americans have diabetes?
25.8 million (8.3%)
What percent of diabetics are Type 1?
Define Polyuria and what causes it in diabetes.
Excess glucose, urea and ketone bodies are excreted and water goes with them
Define Polydypsia and what symptom of diabetes causes it.
Dehydration leads to excessive thirst
What dental issues come with polydypsia?
Define Polyphagia and what symptom of diabetes causes it?
Lack of insulin action on anorexigenic peptide synthesis leads to excessive hunger
What are the acute symptoms of uncontrolled diabetes?
What is Diabetic Ketoacidosis (DKA) caused by?
Insufficient insulin leading to persistent high blood glucose (>300mg%)
What is DKA often associated with?
Infection - 40%
Missed insulin - 25%
Untreated or undiagnosed - 15%
What are other stresses that may be associated with DKA?
What are some symptoms of DKA?
Kussmaul breathing (short breath and increased respiration)
Excessively high blood glucose
What are the 4 main diagnostic tests for diabetes?
Fasting Plasma Glucose Test (FPG)
Oral Glucose Tolerance (OGTT)
What is the pre-diabetic and diagnostic levels of FPG?
100-125 mg% in pre diabetics
>126 mg% is diagnostic
What is the pre-diabetic and diagnostic levels of OGTT?
140-199 mg% @ 2 hr is pre-diabetes
>200 mg% is diagnostic
What is the management goal of Hemoglobin A1c?
What does the C-peptide diagnostic test do?
Verifies Type 1
In the glucose tolerance test are [blood glucose] levels elevated or depressed?
Elevated when compared to normal
When HbA1c levels go up what happens to the blood glucose levels?
It increases at a proportional rate
What is a byproduct of converting proinsulin to mature insulin?
The C peptide
What is the treatment goal of diabetes?
Lower blood glucose level
What is the direct target of weight loss and what is its overall effect?
The direct target is adipose tissue with an overall effect of restoring insulin sensitivity
What is the direct target of exercise and what is its overall effect?
The direct target is Muscle and AMPK Activation with an overall effect of enhancing glucose uptake
What is the direct target of sulfonylureas and what is its overall effect?
The direct target is K+ channel blocker with an overall effect of enhancing insulin secretion
What is the direct target of Biguanides and what is its overall effect?
The direct target is AMPK activator with an overall effect of enhancing glucose uptake
What is the direct target of Thiazoladinediones and what is its overall effect?
The direct target is PPARgamma activator with an overall effect of potentiating insulin
What is the direct target of insulin and what is its overall effect?
The direct targets are muscle and adipose with an overall effect of enhancing glucose uptake
Long term sequelae of diabetes?
CVD and Stroke
End Stage Renal Disease
Prolonged wound healing
What is glycation?
Stable, covalent ketoamine linkage of glucose to amino termini and lysine residues of proteins
What results in glycation?
Glucose spontaneously participating in a Schiff reaction
What are the end products of glycation called?
AGEs or Advanced Glycation End Products
What are receptors of AGEs called?
What do RAGEs trigger?
Increased oxidative stress
Mimics chronic inflammation via NFkB
What are some sequelae of Chronic Vascular Inflammation?
Increased risk for development of atherosclerotic plaques
Impaired flow-mediated dilation
Impaired response to adenosine
Increased stiffness of aorta
Renal & Carotid artery stenosis
How does one diagnose Periodontitis?
Appearance of gingival
Bleeding on probing
Pocket probign depth
Alveolar bone loss
What might perio disease contribute to?
At what percent is HbA1c considered to increased the risk of severe periodontal disease by 3?
What does excess insulin lead to?
What are the symptoms of hypoglycemia?
What should you do if blood glucose is <70 mg%?
Use the rule of 15